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IDEAS

WTS MDS ENDODONTICS - 2008

1. D. All of the above
2. B. Chronic pulpitis
3. C. Lateral spread of caries along DE junction and
weakening of the overlying enamel.
The caries forms a small area of penetration in the enamel at
the bottom of a pit or fissure and does not spread laterally to a
great extent until the DEJ is reached. Force of mastication
fracture the increasing amount of unsupported enamel as the
caries progress so choice (4) is wrong. Destructive potential is
due to acid formed by bacteria by degradation of carbohydrates
so choice (1 & 2) also wrong.
4. B. Vaseline is an ideal choice.
A water-soluble lubricant applied in the area of punched holes
facilitates the proximal contacts. Rubber dam lubricant is
commercially available but other lubricants, even as Having
cream or soap slurry also satisfactory. Cocoa butter and
petroleum jelly, these two are not satisfactory rubber dam
lubricants because both are Oil based and not easily rinsed from
dam once the dam is placed.
5. C. Reversibly denatured collagen.
Affected dentin is softened, demineralized dentin that is not yet
invaded by Bacterua (Zone 2 & 3) Infected dentin (Zone 4 &
5) is both softened contaminated with bacteria.
It includes the superficial, granular necrotic tissue and softened,
dry, lathery dentin. The outer layer (infected dentin) can be
selectively stained by caries detection solutions such as 1%
acid red 52 (acid rhodamine B or food red 106) in propylene
glycol. This solution stains the irreversibly denatured collagen
in the outer carious layer but not the reversibly denatured
collagen in the inner carious layer.
6. A. Maxillary first premolar
Approximately 60% have two roots, one buccal and the other
palatal, each with a single canal. The two roots may be
completely separate or merely twin projections rising from the
middle third of the root to the apex (this is more common). The
two roots are usually equal in length from apex to cusp.
However, the lingual root and canal may be wider. In
approximately 40% of maxillary first premolars, only one root
is present, usually with two separate canals. A cross section at
the cervical line shows a canal shaped like a figure eight
(ellipse). The access opening is a thin oval. Be careful not to
perforate on the mesial (the concavity on the mesial makes
perforation very common). Maxillary second premolars: The
most common configuration in this tooth is a single root,
occurring approximately 85% of the time. Approximately 15%
of the time, two separate roots are present, each with a single
canal. The access opening is exactly the same as that for
maxillary first premolars (thin oval). When only one canal is
present (first or second premolar), it is usually found in the
center of the access preparation. If only one canal is found, but
it is not in the center of the tooth, it is probable that another
canal is present Overfilling either tooth may force materials
directly into the maxillary sinus.
7. C. Mesiobuccal
Canal orifices of a maxillary first molar are arranged in the
shape of a triangle. The orifice to the mesiobuccal canal is
usually the most difficult to locate, since It is under the
mesiobuccal cusp and must be entered from a dlstollngual
position. This canal is the small canal and often splits into two

Explanations
Exp

1

canals. It maybe calcified and difficult to instrument. The
palatal canal is the straightest, widest, and most tapering canal.
The most common curvature of the palatal root is to the facial.
The distobuccal canal is also small and tapering. The orifice to
this canal has no direct relation to its cusp. The distobuccal
orifice is usually located by means of its relation to the
mesiobuccal orifice, with the distobuccal found approximately
2 to 3 mm to the distal and slightly to the palatal aspect of the
mesiobuccal orifice. In approximately 59% of maxillary first
molar teeth, a fourth canal Is present with its orifice being just
lingual to orifice to the mesiobuccal canal. The canal is located
in the mesiobuccal root and may join the mesiobuccal canal or
exit through a separate foramen. If a lesion is present on the
mesiobuccal root prior to root canal therapy and doesn't heal in
the usual amount of time (6-12 months) following treatment, it
is most likely due to a missed canal (mesio-lingual). The Ushaped radlopaclty commonly seen overlying the apex of the
palatal root of the maxillary first molar is most likely the
zygomatic process of the maxilla.
8. A .Maxillary central incisor
9. B. Have film thickness of 1-50 microns.
Liners are relatively thin layers of material used primarily to
provide a barrier to protect the dentin from residual reactants
diffusing out of a Restoration or oral fluid.
Thin film liners (1-50 micron)
Divided into

Solution liners
Suspension liners
(Varnish 2-5 micron)
(20-25 micron)
Thicker liners are used for pulpal medication and thermal
protection. For moderate depth tooth preparation liners are used
for thermal protection and pulpal medication. In very deep
preparation calcium hydroxide liner are used under gloss
ionomer restoration.
10. B. Thin meslodistally but wide lablolingually
Mandibular canines usually have only one root but in rare cases
may have two separate roots. The access opening is a large oval
with the greatest width placed incisogingivally. This tooth
usually has a slightly labial axial inclination of the crown,
therefore the access opening needs to be directed towards the
lingual surface.
11. C. It does not alter dentin permeability.
Reduction in sensitivity may result from formation of Resin
tags and a hybrid layer when a dentin adhesive is used. The
precipitation of proteins from the dentinal fluid in the tubules
also may account for the efficacy of desensitizing solutions. So
after excluding the three option we can have answer.
12. D. Globulomaxillary cyst
An apical scar is represented by a periapical granuloma, cyst, or
abscess that heals with scar tissue. Well- circumscribed
radiolucency resembling a granuloma. Tooth is non-vital. A
radicular cyst usually occurs in a pre-existing granuloma.
Seldom is painful. Radiolucency at apex of non-vital tooth. A
chronic dental abscess is often a result of a periapical
granuloma. Radiolucent area at apex of non-vital tooth. Fistula
is often found leading from an abscess cavity. Once drainage is
established, the tooth stops being painful.
A globulomaxillary cyst is found at the junction of the globulus
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The best method to elicit a most accurate thermal response is to individually isolate the suspected teeth with a rubber dam and then bathe each tooth in hot or cold water. and radiographs. and or. diffuse lytic changes in the bone begin to appear. exam. 17. Thermal tests may be false-negative in immature. An apicoectomy (root resection. It is necessary to gain access to an area of pathosis. The teeth in the area of involvement are loose and sore so that eating is difficult. This later develops into a severe throbbing pain to percussion with swelling of the overlying mucosa. As caries enters the dentin it begins with a lateral spread at the DEJ. but when unprotected. This procedure is used when an apicoectomy alone will not yield a good result Whenever there is any chance whatsoever that an apical seal may be faulty. Radiographically. The tooth may be slightly loose or tender to percussion. For example. recently traumatized teeth or because of premedication with an analgesic. Teeth that have posts in them and need to be retreated are the most common reason for an apicoectomy and a retrograde filling. The tooth will not respond to the EPT or cold test but may respond to heat Treatment of an acute alveolar abscess Includes establishing drainage and debrldlng the canal system of necrotic tissue which will relieve the acute symptoms. As caries progresses. Sensitivity to hot. it would be impossible to obturate most of the canal and get a seal. Removal and examination of the diseased tissue and determination of the extent of the lesion are the objectives of apical curettage. the disease usually remains fairly well-localized to the area of initial infection. A retrograde amalgam filling should always be done after an apicoectomy. the dentin is insensitive. The chronic abscess may be differentiated from cysts and granulomas by the fact that both cysts and granulomas have well-defined radiolucencies associated with them. destruction of dentin is followed by the bacterial invasion of the tubules and complete destruction of dentin. then later decalcification (sclerosis). Explanations Exp 2 Hand cutting instruments are manufactured from two main material carbon steel & stainless steel In addition. When dentinal tubules become completely calcified. Indications for apicoectomy: 1. 15. The first symptom may be a slight tenderness of the tooth. If just the root apex were cut off (apicoectomy). some are made with carbide inserts to provide more durable Cutting edges. The acute apical abscess (AAA) is a localized collection of pus in the alveolar bone at the root apex following death of the pulp with extension of the infection into the periapical tissue. 13. This is done because all other methods may stimulate the tooth at only one section of one surface. Clinically. 2. Carbon steel is harder than stainless steel. In the maxilla. The diagnosis is based on the history. Radiographs will reveal a diffuse radiolucency and PDL thickening. the person afflicted with acute osteomyelitis is usually in rather severe pain and manifests an elevation of temperature with regional lymphadenopathy. between the lateral incisor and the canine roots. Teeth are vital. This Is followed at a later date by conventional root canal therapy. Acute or subacute osteomyelitis may involved either the maxilla or the mandible. If the abscess ruptures through the periosteum into the soft tissue. the foramen is found. Other alloys of Nickel. The earliest common symptom of this edema (acute pulpitis) is thermal sensitivity (usually increased and persistent pain on application of cold). with subsequent necrosis of a variable amount of bone. acute osteomyelitis progresses rapidly and demonstrates little radiographic evidence of its presence until the disease has developed for at least one to two weeks. Despite these disadvantages. The Tomes fibers react. it's the material of choice today. elongated and loose. The only reliable clinical evidence that secondary dentin has formed is decreased tooth sensitivity (usually seen a few weeks after placement of a filling). The general principles of treatment demand that drainage be 2 . B. the buccal bone about the apex is removed. 14. It is a serious sequela of periapical infection that often results in a diffuse spread of infection throughout the medullary spaces. The patient may appear weakened. The tooth becomes more painful. This condition may follow an acute alveolar abscess or unsatisfactory root canal therapy. bone involvement tends to be more diffuse and widespread. This is due to the increased organic content and the involvement of many dentinal tubules. 16. and the area is curetted out. The poorly filled apical portion of the root is to be removed to the level of canal obliteration. Easy to manipulate Short setting time MTA is difficult to manipulate and has a long setting time. 30% to 50% of bone calcium must be altered before radiographic evidence of periapical breakdown occurs (this alteration takes place at the junction between the cortical and cancellous bone). C. B. B. 3. pulpal changes occur. Nickel-Cobalt-Chromium is never used in its fabrication. Initially there is vascular dilation and local edema. the incompletely filled canal might act as a source of reinfection. A reverse filling needs to be placed. cold stimuli Thermal sensitivity is the earliest and most common symptom of an inflamed pulp. a reverse filling material must be placed. if the root canal appears calcified. In the mandible. it will Corrode. To prevent this after the root tip is resected. It is a longstanding. the root apex is removed. Asymptomatic The chronic apical abscess (also called suppurative apical periodontitis) is sometimes so painless that it may go undetected for years until revealed by an x-ray. At that time. and filled with a zinc-free amalgam to create a seal. B. Remember Periapical curettage is the same procedure as an apicoectomy (as far as flap and removal of buccal bone) but without removing the root apex. The treatment is conventional root canal treatment. enlarged. Once odontoblasts are Involved. if not impossible. At times the pain may decrease or disappear completely. the patient's symptoms will subside. irritable and present with a fever.IDEAS WTS MDS ENDODONTICS . It is a developmental (hssural) cyst which arises from cells in a fissural line of bone. Dental Infection It is not a particularly common disease. root amputation) is a procedure where the buccal tissue is flapped back.2008 and maxillary processes of the maxilla. causing fatty degeneration. A retrofllllng (also called a reverse filling or retrograde amalgam filling) is placed to seal the apical portion of the root canal. Cobalt & Chromium are used in the manufacture of hand instruments but they are usually restricted to instruments other than those used for cutting of tooth structure. A "moth-eaten" radiolucent appearance is evident. low-grade infection of the periapical bone with the root canal being the source of the infection.

throbbing and excruciating pain. a Pulpdent syringe) is injected into the canal until it is filled to the cervical level. if pulp capping fails and the tooth becomes symptomatic. therefore. The patient is recalled after three months to see if apexification has taken place. 21. Unfortunately. In thermal tests. A. Alveolar bone loss. pulpotomy procedures performed in fully developed permanent teeth are not found to be successful. It is not uncommon to find uninflamed pulp at a more apical level. If not. Unfortunately. Apexification may be required after pulpectomy as at seven years of age the apex of this tooth must be open. Traumatic or carious exposure of permanent teeth with undeveloped roots. hemostatic agents are used as a compromise treatment. A tooth may stay asymptomatic for several weeks after pulp capping has been performed. more amenable to repair. Pulpal Inflammation (hyperemia) is most commonly caused by bacteria.e. apexification (pulpectomy) procedures should be instituted. These are closely monitored and if vitality is lost. None of the above Apexification Is a technique whose goal is to induce further root development in a pulpless tooth by stimulating the formation of a hard substance at the apex. •An alternative to extraction when endodontic treatment is not available. 20. Pulp capping is overused in dentistry today. If a permanent tooth fractures and has a fully formed root and the pulp is exposed (large exposure). Emergency treatment includes establishing drainage (ideally through the canal) and prescribing antibiotics and analgesics. the treatment of choice is complete root canal therapy. cold. the pulp responds more readily to cold stimuli than to hot (the response leaves shortly after removal of the stimulus). The gingival abscess is a relative rarity mat occurs when the bacteria invade through some break in the gingival surface. The tooth will usually be palpation and percussion positive. Pulp cappings are more successful if the exposure was accidental (trauma or with a dental bur) as opposed to carious. Treatment is root canal therapy. Remember: Apex closes 2-3 years after eruption. pocket formation and periodontal pathologic conditions are suggestive of the periodontal abscess. Periapical abscess Of all the dental abscesses. The pain is spontaneous and is intermittent in nature. However. The paste must reach the apical portion of the canal to stimulate the tissues to form a calcific barrier. then a direct pulp cap with CaOH followed by a restoration is the treatment of choice. C. Radiographs appear normal (may show deep caries or cavity preparation). 22. Pulpotomy is removal of a portion of the pulp. especially in cariously exposed teeth. A premixed syringe of a calcium hydroxlde-methylcellulose paste (for example. or dental treatment.2008 established and maintained and that the infection be treated with antibiotics to prevent further spread and complications. The tooth is usually percussion negative. The dressing most commonly used is CaOH2 (Dycal). It requires an external irritant to evoke a painful response (i. to treat with 3 . If the exposure is small and the length of time is short (1/2 hour to 1 hour). For endodontic infections that do not respond to penicillin. A double seal of cement is made to close off the access cavity. The radiographs will usually disclose no periapical pathology. The technique consists of isolation of the field with a rubber dam. Treatment usually Is a sedative filling or new restoration with a base.. ceasing when the irritant is removed. D. This will relieve the acute symptoms followed by conventional endodontic therapy at a later date. Accidental exposure of the pulp Pulp of a young child Pulp capping is the placing of a sedative and antiseptic dressing on an exposed healthy pulp in order to allow it to recover and maintain normal function and vitality. Bacteria associated with this abscess include gramnegative rods such as Capnocytophaga species. 18. clindamycin is often recommended. If not Impossible. Perform the amputation at a more apical level Uncontrolled bleeding is a sign of inflamed pulp tissue. Usually they both will cause severe and lasting pain. Repair is accomplished by the formation of a dentin bridge at the site of exposure. Such abrasions may be the result of mastication. C. Apexification is not needed because the root is fully formed. The common Indications include: Cariously exposed deciduous teeth -> with healthy radicular pulps. If apexification has occurred. Even a small carious exposure should have root canal therapy for the best long-term prognosis. the periapical is the most common type. This later develops into a severe throbbing pain (acute abscess) with swelling of the overlying mucosa. The tooth will not respond to the EPT or cold tests but may respond to heat. If bleeding does not stop even after more apical amputation. Reversible pulpitis (hyperemia) -» the pain associated with hyperemia does not occur spontaneously. it may be difficult. sweets). Irreversible pulpitis The severity of the clinical symptoms will vary as the inflammatory response increases. The periodontal abscess is an acute abscess that develops through the periodontal pocket. The pains are sharp and of brief duration. In reality it has only very few indications for its use. For this reason it is regarded as a temporary procedure in these teeth. In addition. It produces high bone levels and is effective against anaerobic bacteria but must be used with caution because of the potential for pseudomembranous colitis. Emergency treatment in permanent teeth with acute pulpitis. Pain will vary from a mild and readily tolerated discomfort to a severe. so as to allow Explanations Exp 3 obturation of the root canal space. The pain is usually not readily localized by the patient but is diffuse in character. Vibriocorroding organisms and Fusobacterium species. The tooth may be tender to percussion. a fresh supply of paste is placed. 19. conventional root canal therapy is instituted. oral hygiene procedures. The pain lingers after the removal of the irritant. The action of calcium hydroxide in promoting formation of a hard substance at the apex is best explained by the fact that calcium hydroxide creates an alkaline environment that promotes hard tissue deposition. The first symptom may be a slight tenderness of the tooth. the exposure should only be pinpoint to expect success. The radicular pulp must be uninflamed for the success of this procedure. It is a localized collection of pus in the alveolar bone at the root apex following death of the pulp with extension of the infection into the periapical tissue. Lying down or bending over intensifies the pain of irreversible pulpitis because the overall increase in cephalic blood pressure is relayed to the confined pulp tissue. heat may intensify the pain response while cold may relieve it (in advanced stages). It will respond to the electric pulp tester (unlike the pehapical abscess). B. making an access cavity and removing all pulpal tissue by the use of reamers and files.IDEAS WTS MDS ENDODONTICS . this may be only temporary. Young pulps are more vascularized and.

tissue fluid and microorganisms from the periapical tissues are able to enter the voids. 27. Gram negative anaerobic micro organisms are the main causative agent of endodontic infections while pseudomonas is aerobic. These agents act on calcified tissues only and have little effect on periapical tissue.25% NaOCI solution for one minute. If the canal is not filled. D. The inactivator for EDTAC is NaOCI. Its vapor is potentially hazardous so it is dripped directly in the canal avoiding excessive flooding. If an accurate determination and careful enlargement have been performed.IDEAS WTS MDS ENDODONTICS . removal. and canal enlargement is facilitated. A gutta-percha cone the same size as the file used last during preparation (MAF) is selected and placed as far as possible into the canal. When the cone is slightly short. this time consuming procedure can be reserved for the other indications listed on the front of the card. Eucalyptol is the reagent of choice to dissolve guttapercha gutta-percha is slightly soluble in Eucalyptol. and reestablishment of the PDL 25. 28. 24. A glass bead sterilizer can sterilize endodontic files in 15 seconds at 220° C (428° F). The tooth responds to thermal tests This indicates inadequate debridement as a pulpless tooth should not respond to any stimuli. which combine with the dentin to give soluble salts for the calcium ions that are bound in less soluble combination. However. Approximately 40% of failures are believed to be caused by incomplete obliteration of the root canal. a quaternary ammonium compound. For this reason. EDTA will remain active in the canal for 5 days If not inactivated. It has greater antimicrobial action than EDTA. "Tugback" within 1 mm of working length Since studies show that solvent softening does not ultimately result in a better apical seal. essential oils. It is also an excellent Irrigation solution it has a limited value as irrigation solution. fitting the master cone is not a time-consuming procedure. A. benzene. Chelating agents are used to aid and simplify preparation for very sclerotic canals after the apex has already been reached with a fine instrument. the appropriate treatment is to observe the tooth and evaluate every three months. halothane. any organisms that have entered the periapical tissues from the canal are eliminated by the natural defenses of the body. a radiograph is taken to verify cone positioning. D. Their action is to substitute sodium ions. File and chemical removal. The foamy solution has a natural effervescence that is increased by irrigation with NaOCI to aid in the removal of debris. Among aerobes alpha hemolytic streptococci were the most commonly recovered microorganism. The edges of the canal are thus softer. the x-ray will show that the master cone reaches the most apical position of the preparation or extends to a point just short of that (1 mm). Other chemicals which can dissolve gutta-percha to a varying degree include: xylol. Highly concentrated chloroform is very effective but should be used with caution. it usually takes 6-12 months before marked reduction in the size of the radiolucency is evident on an x-ray. RC-PREP combines the functions of EDTA plus urea peroxide to provide both chelation and irrigation. After endodontic therapy is completed on a tooth with a periapical radiolucency. Traumatic blows to teeth are also a cause for calcification of the pulp space sometimes to a point where locating the canal is very difficult. Heat and instrument. Complete debridement of the canal is the most effective means to reduce root canal microorganisms. deposition of apical cementum. The most important consideration before filling a root canal is proper cleaning (debridement) and shaping (instrumenting) of the canal. The most common 4 . However. A. 23. A. which in turn cause a yellowish discoloration of the tooth. Ultrasonic removal. Desired periapical tissue changes include regeneration of alveolar bone. placement of medicaments and irrigants and / or surgery. if an accessory canal is not totally filled during obturation. at the completion of the appointment the canal must be irrigated with a sodium hypochlorite (NaOCI) containing solution. the pressure of condensation plus the lubricating action of the sealer wilt be sufficient to produce complete seating of the cone. Gutta-percha points may be disinfected by placing them in a 5. It can be carried out in various ways as the case demands. The attainment of a clean irrigating solution is considered an inaccurate way to determine the end point of debridement. Once satisfactory tugback and apical positioning appear to be obtained. Perforations may occur during attempts to follow the obliterated canal to gain patency to the apex. Heat removal." The cone should also have a definite apical seat -► it should not be able to be pushed further apically. The main reason for recapitulation (using your MAF after each increase in file size) during instrumentation of the canal is to clean the apical segment of the canal of any dentin filings that were not removed by irrigation. Objectives of root canal obturation: To develop a fluid-tight seal at the apical foramen Complete filling of the root canal space To create a favorable biologic environment for the process of tissue healing In endodontic treatment the importance of canal obliteration (filling) is second only to canal debridement. EDTAC is EDTA with the addition of Cetavlon. with failure as the ultimate result. If the cone is more than 1 mm from the radiographic apex. A broken cone in the periapical area may result in an orthograde re-treatment failure. Debridement is defined as the removal of foreign material and contaminated or devitalized tissue from or adjacent to a traumatic infected lesion until surrounded healthy tissue is exposed. Chemomechanical debridement of the root canal system is the most crucial aspect of root canal treatment. Note: Perforations into furcations of multi-rooted teeth have the poorest prognosis. The decalcifying process induced by EDTA is self-limiting and stops as soon as the chelator is used up. but not beyond the working length. Explanations Exp 4 The microorganisms identified in periradicular infections of endodontic origin are similar to bacteria isolated and identified from within the root canal. 26.2008 routine because of the severe calcifications in the root canal. methyl chloroform and white rectified turpentine. Pseudomonas. Once the canal is obturated. it has greater inflammatory potential to tissue as well. C. carbon disulfide. trauma may cause calcifications in the pulp chamber. Techniques to remove guttapercha include: Rotary removal. With primary teeth. If the preparation is properly flared. and may include instrumentation of the canal. If a gutta-percha cone has passed beyond the apex then a file must be used beyond the apex in order to avoid breakage of the cone. discard the cone and fit a smaller one or instrument more in the apical third. This slight resistance to dislodgement is referred to as "tugback. To achieve glassy smooth walls of the canal Clean shavings are difficult to see on a file.

This is done all the way around the tooth until all the dentin walls have been planed. It is a method of filing whereby the instrument is moved first towards the buccal side of the canal. resorptive areas.2008 cause of root canal failure is incompletely and inadequately disinfected root canal systems. determines the general shape of the canal preparation. however. These files are the strongest of all files and cut the least aggressively. Reamers are manufactured in a manner similar to files.5 to 1. Non-vital pulp. use only the reaming motion. Filing is a push-pull action with emphasis on the withdrawal stroke. When a canal is properly prepared. 34. the barbs wilt be bent and will engage the walls. therefore. tapered preparation. rather than the instrument used. This is common even after apical curettage. They remove intracanal debris with clockwise reaming action. producing a series of cutting flutes. Its efficiency is greater with files than with reamers for removing dentin because of the greater number of flutes in contact with the canal walls during the rasping motion of removing the instrument. The second most common cause of failures of root canals is leakage from a poorly filled canal. They are also used to place materials into the apical potion of the canal by using a counterclockwise rotation. The response of vital pulp to microbial Invasion is very resistant. C. since it may disclose the presence of accessory canals. 31. The appearance of the canal is approximately round (this method is recommended if using a silver cone to fill canal). In fact it is said that it is more important than the core filling material. The appearance of the canal is irregular and for this reason a canal prepared with this action must be filled with gutta-percha in a condensation procedure. Broaches The barbs are notched out of the instrument shaft and represent a weakened point If the broach is not used with the utmost of care or if it is forced apically. If used carefully. Carious exposures in permanent teeth generally require root canal treatment. Polymorphonuclear (PMN) Leucocytes The onset of pulpal inflammation is an insiduous process and is characterized by a chronic cellular response (plasma cells. if you see a horizontal line of material (gutta-percha or sealer) extending both mesial ly and dlstally from the canal to the periodontal ligament space. only they have fewer flutes. macrophages and lymphocytes).IDEAS WTS MDS ENDODONTICS . 30. is a "fertile ground" for the growth of microorganisms. A canal should be instrumented and shaped so that it has a continuously tapering funnel shape. 29. Three years later the lesion is even bigger than it was before.0 mm from the radiographic apex). Round In shape Studies have shown that the action of using the instrument. and removed slightly mesially. therefore their presence can be demonstrated on a radiograph. This is an important property. 32. 35. A modification of this file is the S-file. This is where all teeth should be filed to and filled to (ideally). the tissue is likely to show signs of acute inflammation near the site of the exposure and a band of chronic inflammatory cells between the acute inflammation and the underlying normal pulp. root fractures. D. D. it will successfully plane the dentin walls much faster than K-type files or reamers. and the shape of the apical foramen and other structures of interest. this is Indicative of a root fracture. After pulp exposure. rotating cutter to gauge triangular segments out of a round blank shaft. All of the above The engine driven instruments. Reaming is defined as the repeated clockwise rotation of the instrument. a reaming action produces a canal that is relatively round In shape while a filing action produces a canal that is irregular In shape. You can have an idea about its resistance from the observation that even after two weeks of traumatic exposure of the pulp. Example: Root canal treatment performed on a tooth with apical curettage of a lesion that was found to be a cyst. The action used for placing this type of file into a canal should resemble a clockwisecounterclockwise motion with pressure directed apically (can be a filing or reaming action). incontrast. They are used in canal preparations to shave dentin with a reaming action only. making removal difficult. They are manufactured by twisting a blank. There is no direct exposure of the pulp to dental caries and the response. All of the above are made of stainless steel. Long history of successful usage This alone outweighs its disadvantages of staining. slow setting time. D. Reamers are usually most efficient for this function. non-adhesion and solubility. This activity is the highest In the period of time Immediately after Its placement Most root canal sealers are some type of zinc oxlde-eugenol cement and are capable of producing a seal while being well-tolerated by periapical tissues. Explanations Exp 5 Chromic gut sutures consist of plain gut treated with chromium trioxide this result in delayed absorption rate. which is a square rod. hand instrumentation is done by either filing (push and pull) or reaming (repeated rotations). The most likely cause of this failure is leakage from a poorly filled canal. the acute inflammatory cells (mainly PMN cells) are chemotactically attracted to the area. Immature (open apex) 5 . Collagen is basic component of plain gut suture material. C. Permits restoration to withstand occlusal forces. A modifcation to this type of file is the K-flex file. The widest diameter would be at the canal opening and the narrowest at the dentinocemental junction (. The collagen is treated with diluted formaldehyde to increase in strength. Its absorption is faster than the plain gut sutures. with filing action only. facilitating placement of the gutta-percha To form a bond between the filling material and the dentin walls To exert antibacterial activity (some exert more than others). All sealers display some degree of radiopaclty (caused by metallic salts in the sealer). D. Nickel titanium instruments can be bom hand operated and engine-driven. This technique enhances preparation when a flaring method is used. 33. K-type instruments: Flies are the most useful instruments in for the removal of hard tissue in canal enlargements. Histologically. Circumferential filing is a push-pull action with emphasis on scraping the canal walls to create a smooth. Other purposes or functions of a root canal sealer include: To act as a lubricant. then reinserted. Therefore. is not acute. After filling a tooth with gutta-percha. any of the accepted methods of filling will almost certainly produce a successful result (as long as the canal is completely filled). This produces a very sharp edge and therefore an effective cutting instrument. only 2 mm of the coronal pulp may "give in* to microorganisms. Evidence indicate that plain gut is more biocompatible with oral soft tissues than is chromic gut. The primary function of a root canal sealer is to fill in the discrepancies between the corefilling material and the dentin wall. H-type Instruments: Hedstrom flies are manufactured by using a sharp. B. Generally. particularly during Insertion.

Be very careful when placing posts. Its disadvantages include hemorrhage from the cut margins and scarring. B. 37. Symptoms from this condition usually are characterized by a sharp but brief pain occurring unexpectedly only when the patient is chewing. Pulp capping is not recommended in primary teeth with carious exposures due to its high failure rate and because pulpotomy. This wide outline of the flap precludes any incisions over bony defects and allows various periodontal procedures including curettage. have an almost hopeless prognosis. A. A. One of the most puzzling and frustrating dental conditions involving the possible need for endodontic treatment is the cracked tooth syndrome. 39. 0.01 microns. muscles etc. Full mucoperiosteal flap allows maximal access and visibility. suspect a fractured cusp (using a bite stick wilt help determine which cusp may be fractured). 41. Vertical fractures through root structure. A. A common clinical finding of a periodontal problem is pain to lateral percussion on a tooth with a wide sulcular pocket. Less risk of incising over bony defects and no post-surgical recession of gingiva. 38.2008 permanent teeth with carious exposures can be treated by pulp capping or pulpotomy procedures. Healing occurs by scarring 4) Its extent is also limited by attachments (e.005 – 0. The minimum (most conservative) preparation should be for an onlay covering the cusps and marginal ridges. Access and visibility is better (and acceptable) than semilunar flap but not as good as full Explanations Exp 6 mucoperiosteal flap. frenum.IDEAS WTS MDS ENDODONTICS . unrealistic or overambitious case selection leads to a high degree of failure. another clue for diagnosis is a non-vital (necrosed) pulp -» these two lesions can completely heal after root canal treatment. Perforations and vertical root fractures can occur. Acute or blowout lesions -» a tooth with this type of lesion will show normal sulcus depth all the way around the tooth until the area of the swelling is probed. Once the root canal treatment is completed. it generally occurs in a more horizontal plane and may show up on the x-ray. A conical shaped probing In "blow-out type" and "sinus tract type" probings. however. the lesion heals within one week. If the fracture line is not too far down the root of the tooth. Nano fillers are about 7 mm range and used in modern composite as they penetrate the typical key hole etch pattern of enamel as well as smallest dentin channels. A perio-endo abscess is a combined lesion. 36. At this point. D. D. Endodontically treated posterior teeth are more prone to fracture than untreated posterior teeth due mainly 6 . Microdentristry uses A12O3 particles of 27 micron range. the use of a post and core is often indicated. Inlays have been shown to be a cause of fractures.02 – 2 µm) Because these particles do not interact with visible light they do not produce scattering or significant absorption. However. New composites are being developed with nanofillers that ranges in size from 0. you need to place amalgam 3 mm Into each canal for retention. The probing depths in all other areas are within normal limits. a cuspal coverage restoration would provide protection from fracture.g. Options available when restoring endodontically treated posterior teeth: Restoration of occlusal opening only -» in rare Instances the access opening and caries destruction do not encroach on the cusps and marginal ridges. A narrow sinus tract type lesion --> the probing reveals normal depths all around the tooth except at one very narrow area. the probe can pass down the root surface to some distance and sometimes even to the apex. The parallel-sided posts are preferred. Threaded screw posts are preferred over parallel sided and tapered posts These may actually increase the chance of fracture. It is raised by a scalloped incision in the attached gingiva with one or two vertical incisions. When an anterior tooth fractures. Post surgical gingival recession is also a possibility. Crown -» a full-coverage crown is preferred when the remaining coronal tooth structure does not afford sufficient tooth structure for an onlay. Crown with post and core -» to reinforce the treated tooth and provide suitable coronal tooth structure for an optimum crown preparation. in mechanical exposures. Tooth socket 40. This type of lesion may not be amenable to root canal treatment alone even if it is associated with a pulpless tooth. If the fractured segment can be removed and gingivoplasty and alveoloplasty performed. If you are performing a pulp chamberretained amalgam. root planing and bone re-shaping. however. the incisions come to lie over the bony defect.01 micron which is below the wavelength range for visible light (0. the disadvantages outweigh its advantages. A large flap may be difficult to reposition.005 – 0. However. Having a patient bite forcefully on a bite stick and noticing the cusps that occlude when the pain occurs will aid in the location of the offending tooth. If a patient complains of pain on mastication since the placement of an inlay. Pulp capping can be done.) Submarginal triangular and rectangular flap (OchsenbeinLeubke) requires at least 4 mm of attached gingiva and a healthy peridontium. it may be able to be saved with a root canal and a crown. has shown to be very successful. the probe drops suddenly. The tooth is pulpless (non-vital). The cause is usually accidental trauma such as a blow to the jaw or teeth. endodontic treatment must be completed prior to tackling the periodontal problem. however. to a level near the apex. Here. Periodontal lesions characteristically show bone loss which begins at the crestal bone level and progresses apically. It is raised from the gingival sulcus (elevating gingival crest and interdental gingiva). These include: 1) Limited access and visibility 2) Tearing of comers of the incisions when an attempt is made to improve accessibility by stretching the flap 3) If somehow a lesion is found to be bigger than anticipated. These teeth may be restored with an occlusal amalgam. Although it's simple and does not impinge on the surrounding tissue. suture and make alterations. Onlay restoration -> In most cases it is Imperative that root canal treated teeth be protected from fracture by a cuspcoverage type of restoration.. A vertical fracture of the tooth Radiographic examination seldom reveals the fracture because the crack is usually parallel to the x-ray film. Hence probing defect would be conical in shape. A submarginal curved flap A submarginal curved flap also called semilunar flap This half-moon shaped flap is raised with a curved horizontal incision in the mucosa or attached gingival with the concavity towards the apex. treatment can be successful. having similar time requirements. The lesion usually demonstrates radiographic involvement of the periodontium and the apex of the involved tooth.

and refill.5-6. Five factors that are critical to the management of traumatic avulsion injuries to teeth: Time -> the time interval from injury to replacement of the tooth is a major factor in the maintenance of ligament viability and subsequent root resorption. It is necessary to gain access to an area of pathosis.. or manipulated with caustic chemicals.g. blockage or severe root curvature in which non-surgical treatment is impossible. which is a specific receptor for pain. it is usually best to try and retreat it conventionally -> remove filling material.g. pressure). debride the canals.The size of the pulp As the pulp ages there is a decrease in reticulln fibers (the pulp becomes less cellular and more fibrous). and a retrofill should be performed. Regardless of the source of stimulation (heat. 43. D. separation of instruments. Note: All of the other statements on the front of the card are true and must be remembered. Saliva can allow storage of the tooth up to 6 hours 'This is false. C. The size of the pulp also decreases because of the continued deposition of dentin. The only type of nerve ending found in the pulp is the free nerve ending. yet surgery is impractical When a previous treatment has failed but nonsurgical treatment or surgery is impractical. However.IDEAS WTS MDS ENDODONTICS . Mantle dentin -> is first-formed dentin which is laid before odontoblast layer gets organized. whereas most of the teeth replanted after 2 hours show a lot of external root resorption (which is the main cause of failure of replanted teeth). and the tooth is returned to its original socket. ankylosis. Indications for intentional replantation (also called replant surgery): When routine endodontic therapy of a tooth is Impractical or Impossible When an obstruction of a canal is present. due to trauma or infectious process) it predisposes the dentin to internal resorption by odontoclasts. cold. 45.2008 to the destruction of the coronal tooth structure -* they have reduced structural integrity. 1047 iim of the dentin matrix remain unmineralized. such as a broken instrument or a calcification. Tooth socket -» should not be damaged by curettage or forceful replantation. Curettage of the socket to remove periapical pathosls This is probably unnecessary. apicoectomy. C. ledging and/ or perforations) which cannot be handled without surgical exposure of the site. Dentin formation is the primary function of pulp. Other storage media are physiologic saline and saliva. Horizontal apical fractures in which apical end of the pulp becomes necrotic. dried. Root surface -» should not be scraped. Predentin Immediately adjacent to the odontoblast layer in the pulp. patient with a history of previous malignancy. Clrcumpulpal dentin -> represents most of the dentin which is formed. (e. Long term follow up is required to monitor for complications including periodontal defects and ankylosis with replacement resorption. Intentional replantation should be considered only when there's no other alternative treatment to maintain a "strategic" tooth. infection. 44. The myelinated fibers are sensory and the unmyelinated fibers are motor -» they play a role in the regulation of the lumen size of the blood vessels. Tertiary dentin or reparative dentin -» is an irregular and disorganized layer of dentin laid down in response to any injurious / irritant stimuli. C. In fact. Proper management of an avulsed permanent tooth that has been replanted within two hours of the accident: Ten days to two weeks after replantation. The above information changes when a tooth has been out of the mouth for more than 2 hours -* mainly the treatment of the tooth socket and root surfaces as well as the time for splint stabilization. Splint stabilization -» a splint that allows the physiologic movement is placed for a maximum of 2 weeks. Biopsy -> to diagnose non-odontogenic causes of symptoms. saliva is hypotonic and can therefore allow storage up to 2 hours. and periapical surgery is impractical (a lower molar with the mandibular canal in close proximity).g. lip parsthesia or anesthesia). 7 .. Indications of peiiradicular surgery: Non negotiable canal. 47. The pulp contains both myelinated and unmyelinated nerve fibers.8) and osmolality. socket wall should be minimally manipulated. conducive for the survival of cells. the proper storage of the tooth can favorably influence the viability of PDL cells. If a tooth has had previous endodontic therapy and becomes reinfected. Teeth replanted within 30 minutes have been reported to exhibit very little resorption. C. Storage media -» if the tooth cannot be immediately replanted. Of the most apical portion of the root An apicoectomy is best accomplished by obliquely resecting the most apical portion of the involved root. They are afferent and sympathetic. The poorly filled apical portion of the root is to be removed to the level of canal obliteration. When perforating Internal or external resorption is present. 42. Hence the pattern of deposition and size of collagen fibers is different from circumpulpal dentin.g. and crown then apical curettage.Digital Fibre optic trans-illumination 46. D.. Indications for apicoectomy: A reverse filling needs to be placed. Other functions include: Explanations Exp 7 Induction -» forms dentin which in turn induces enamel formation Nutrition -» dentinal tubules are linked to the pulp which maintains its hydration and formation of peritubular dentin. Pulp stones are associated with chronic pulpal disease »from advanced carious lesions or large restorations. If this unmineralized layer of dentin is lost (e. Leave the tooth and come to the office Immediately Replantation of a primary tooth is not recommended because of the potential danger to the permanent successor from sequels of trauma (e. This time period allows for the initial reattachment of the periodontal ligament fibers. Intentional replantation implies that a tooth requiring endodontic therapy is purposely removed from its socket. C. Failed treatment due to irretrievable posts or root fillings. Maximum storage time of 6 hours is reported for milk. or damage due to manipulation during procedure itself). Milk is considered best for this purpose because of its near neutral pH (6. if the tooth has been restored with a post.. the only response will be pain. As the pulp ages there is an increase in the number of collagen fibers and calcifications within the pulp (called denticles or pulp stones). core. some type of canal or apical preparation and / or filling is performed. Proprioceptors (which respond to stimuli regarding movement) are not found in the pulp. 48. Complications arising from procedural accidents (e. Secondary dentin -» forms after eruption of a tooth and throughout life resulting in a gradual but asymmetric reduction in pulp size.

It is employed during the treatment of subgingival caries perforations and resorptions. Stieglitz forceps 54. and splint for 4-6 weeks. Combined endodomtic-periodontal therapy is widely used because the anatomic and clinical connections between the pulp and periodontal structures are close and numerous. The radiolucent lesion inside the canal space will not shift. resorptive lesions and perforations in the cervical area. This is often seen in unsuccessful replant cases. pulp capping with calcium hydroxide. Indications include unbeatable subgingival pathoses e. In some doubtful cases.5 for 20 minutes or more. dental caries. which resorb the tooth structure in contact with the pulp. Histologically.4% fluoride solution acidulated at pH 5. an external resorptive lesion can superimpose the canal space to mimic internal resorption. it appears that the resorption has stopped. all resorption ceases.IDEAS WTS MDS ENDODONTICS . resulting in ankylosis.2008 the root canal is prepared (cleaned and shaped) and a calcium hydroxide paste is placed into the canals. Three different types of resorption have been identified: surface. The fluoride will slow the resorptive process. A calcium hydroxide paste is placed in the canal. It will appear as an irregular radiolucency anywhere along the canal space. D. "Pink" tooth Is considered to be pathognomonic of replacement resorption Traditionally pink tooth has been considered pathognomonic of internal resorption but it is not an uncommon feature of cervical root resorption as well. It is characterized by a pinkish appearance of the tooth due to growth of granulation undermining the coronal dentin. dental Explanations Exp 8 trauma (resulting in damage to attachment apparatus).alveolar ankylosis resulting from extensive trauma to the attachment apparatus of the tooth is characterized by progressive replacement of the root by the bone. In such cases. 50. Transplantation is the transfer of a tooth from one alveolar socket to another either in the same person or in another person. Root submersion involves resection of tooth roots 3 mm below the alveolar crest and then cover with a mucoperiosteal flap. The tooth is soaked In a 2. This type of resorption is rapidly progressive and will continue if treatment is not instituted. healing takes place with new cementum and PDL. Once the pulp tissue responsible is removed. the process can be arrested by immediate root canal treatment. adverse periodontal conditions and in cases that have had repeated prosthetic failures. This is replaced every three months for one year. Replacement resorption refers to resorption of the root surface and its substitution by bone. B. periodontal defects. C. All of the other statements on the front of the card are true and must be remembered. Rinse tooth with saline. the value of precise pocket probing and correct appraisal of the vitality of the pulp is crucial. 49. Root canal therapy is performed in its entirety prior to replantation.g. Endodontic treatment followed by periodontic treatment tn a combined perio-endo lesion. this is also done to avoid formation of an esthetic defect that may result after extraction. Inflammatory resorption Bowl-shaped areas of resorption involving cementum and dentin characterize external inflammatory root resorption. Ankylosis resulting from replacement would give a better prognosis than external resorption. internal resorption can occur only when some of the pulp tissue is still vital. Internal (inflammatory) resorption is usually asymptomatic and is discovered on routine radiographic evaluation. resulting In ankylosis. it appears that resorption has reversed or stopped. Sometimes. excessive orthodontic forces. Surface resorption is caused by acute injury to the periodontal ligament and root surface.. which lead to failure. C. Indications include rampant caries. periodontal cyst 52. a permanent guttapercha filling can be placed. In these cases. To "wait and see" may result in sufficient destruction of the tooth to create a perforation of the root. If after one year. another radiograph should be exposed at an angle to the tooth. cracked tooth. a pulpectomy should be performed. Also remember that sometimes on a radiograph. Intentional replantation Is a viable alternative to endodontic surgery Intentional replantation is not a substitute for endodontic surgery if it can be undertaken. C. 51. Crown lengthening is a procedure used to apically position the gingival margin and / or to reduce the cervical bone. impacted teeth. are followed by periodontal measures. endodontic procedures are preformed first and. The tooth is opened and the canal is cleaned and shaped. In most cases of this nature. cervial fracture. a negative sensibility test does not rule out this etiology. Internal resorption -» dental trauma (resulting in loss of vitality and subsequent infection). This is especially useful in medically compromised or handicapped patients requiring better denture control. replant into socket. inflammatory and replacement (ankylotic resorption). A calcium hydroxide-based root canal sealer is strongly recommended. The etiology of external and Internal resorption: External resorption -* periradicular inflammation. Inflammation due to an infected coronal pulp This condition is frequently precipitated by traumatic injury to the tooth. Gently curette blood clot out of the alveolar socket and Irrigate with saline. This paste is replaced every three months for one year. Important: If a tooth is out of the mouth for more than two hours : Ankylosis and external root resorption will probably result within two years. Orthodontic extrusion is defined as force-controlled vertical tooth movement occlusally in the socket. If injury is not repeated. B. Typical radiographic appearance of internal resorption Although. The anatomic configuration of the root canal is altered and increases in size with internal resorption. when necessary. Replacement resorption refers to resorption of the root surface and its substitution by bone. Resorption is the most frequent sequela to replantation. Undifferentiated reserve connective tissue cells of the pulp are activated to form dentinoclasts. the better part of wisdom is to wait until after the completion of the root canal therapy to see whether spontaneous resolution (pocket closure and osseous fill-in) will 8 . If after one year. bleaching of nonvital teeth. This condition's pathognomonic signs are: Lack of mobility Metallic sound to percussion Infra-occlusion of the involved tooth in the developing dentition 55.When internal resorption is detected. C. endodontic treatment generally takes precedence over periodontal management. Since both a necrotic pulp and the presence of bacteria are necessary components of inflammatory resorption. a permanent root canal filling (gutta-percha) can be placed. The tooth involved may respond to pulp vitality tests. The submerged roots will prevent alveolar resorption and maintain better proprioception. cervical caries. 53. it shows direct contact between dentin and bone with no intervening PDL or cemental layer. which accompanies dento. Replacement resorption.

Calcification may occur around a nidus of degenerating cells. Chronic open pulpitis Chronic hyperplastic pulpitis or “pulp polyp” is a productive pulpal inflammation due to an extensive carious exposure of a young pulp. Ideal access results in straight entry into the canal orifice. It has been demostrated that 5. Pulp & supporting tissue 59. 63. Provide straight line access to the apex The objectives of access cavity preparation are: 1. A common clinical finding of a periodontal problem is pain to lateral percussion on a tooth with a wide sulcular pocket. and through the soft tissue and bone. covered at times with epithelium and resulting from long-standing. B. at the bottom 74. endodontically treated tooth. Cold can be applied in several different ways such as: Stream of cold air Ethyl chloride spray/cotton pellet saturated with ethyl chloride Ice in wet gauze/ ice pencils Carbondiozide (dry ice) snow – 780C temperature. at times. the patient can quickly point to the painful tooth. Gutta percha cones may be kept sterile in screw-capped vials containing alcohol. 56. a young. followed by incision of the soft tissue and artificial fistulation of the bone to establish drainage. C. The open-drainage technique is preferable to one in which the prepared root canals are sealed. concentric pulp stones. B. a fleshy. Proper instrumentation 68. Grey matter of spinal cord 64. Remineralization 70.2% sodium hypochlorite for 1 min. A. The appearance of the polypoid tissue is clinically characteristic. gastrointestinal disturbance. Mechanical irritation from chewing and bacterial infection often provide the stmulus. D. blood thrombi. then rinse the cone with hydrogen peroxide and dry it between 2 layers of sterile gauze. When mixed into a paste with superozol. water soluble white powder which decomposes into sodium metaborate and hydrogen peroxide. Sodium perborate is a stable. D. to determine sensitivity to thermal changes. Many authors believe that this represents a form of dystrophic calcification. one should establish drainage through the root canal. It is characterized by the development of granulation tissue. Slow. It is not successful in wet field 73. Irrigation of root canal 71. 57. malaise. Many authors believe that this represents a form of dystrophic calcification. C. 58. To sterilize a guttaPercha cone freshly removed from the manufacturer’s box. When a reaction to cold occurs. B. Does not relate to the periodontal condition Calcification of pulp tissue is a very common occurrence and is unrelated to the periodontal condition of the tooth. B. 66.2% sodium hypochlorite is more effective than sporicidin and as effective as activated dialdehyde (cidex) for sterilizing gutapercha cones. C. relaeasing oxygen. continuing its activity over a longer period of time. The condition is usually symptomless and is generally seen only in the teeth of children and young adults. with the line angles forming a funnel that drops smoothly into the canal. 9 . Superoxol is a 30% solution of hydrogen peroxide by weight and 100% by volume in pure distilled water. 2. B. Open root canals permit drainage and frequently eliminate the need for a surgical incision as well as the routine administration of oral antibiotics and analgesics. Periodontal therapy should be initiated first only in the case of a primary periodontal lesion with subsequent secondary endodontic involvement. Chemical solutions The method of choice for sterilization of gutta percha is chemical solutions. low-grade stimulus are necessary for the development of hyperplastic pulpitis. preferably. 60. depending on the degree of local involvement and the amount of tissue destruction. D. Pain of pulpal origin Thermal testing involves the application of cold and heat to a tooth. calcification usually takes the form of discrete. When prepared correctly. B. Superoxol Walking bleach technique is used for bleaching a discolored. Calcification may occur around a nidus of degenerating cells. A. A. this paste decomposes into sodium metaborate. 69. if necessary. To locate all root canal orifices 3. water and oxygen. regardless of whether that pulp is normal or abnormal. low-grade irritation. reddish pulpal mass pulpal mass fills most of the pulp chamber or cavity or even extends beyond the confines of the tooth. All of the above 61. To conserve sound tooth structure. B. To achieve straight or direct-line access to the apical foramen or to the initial curvature of the canal. or collagen fibers. the access cavity allows complete irrigation. Dentinal chips along with a & b 67. In the coronal pulp. calcification tends to be diffuse. To relieve this constant pain as an emergency measure. B. progressive carious exposure of the pulp is the cause. The numbers of flutes on the blade are more in files than in reamers. The prognosis for the tooth is generally favourable. Luxation of teeth as a result of trauma may result in calcific metamorphosis. straightline path to the canal system and ultimately to the apex. one should immerse it in 5. A response to cold indicates a vital pulp. and a chronic. blood thrombi. C. resistant pulp. nausea. Calcification replaces the cellular components of the pulp and may possibly hinder the blood supply. Superoxol can be used alone or mixed with sodium perborate into a paste for use in the “walking bleach”. dizziness and other symptoms related to continuous pain and lack of sleep. it oxidizes and discolors the stain slowly.2008 occur before surgical periodontal procedures are begun. or collagen fibers. 72. D. Establish drainage An acute apical abscess is accompained by a severe local reaction and. shaping and cleaning and quality obturation.IDEAS WTS MDS ENDODONTICS . subsequently causing partial or complete radiographic obliteration of the pulp chamber. Immature teeth Explanations Exp 9 65. When sealed into the pulp chamber. Periphery. The cause of pulpal calcification is largely unknown. whereas in the radicular pulp. A large open cavity. A properly prepared access cavity creates a smooth. a general reaction of systemic toxicity such as elevated temperature. Both a & b 62.

Explanations Exp 10 90. Sodium hypochlorite The ultrasonic instrument consists of a piezoelectric ceramic unit that generates ultrasonic waves. B. B. B. C. Galvanic currents. Pathological resorption of root apex (due to abscess). Heat generated by injudicious cutting. Pulp is bounded by rigid dentin The encasement of pulp in the dentin creates an environment that allows only small amounts of intracellular accommodation of exudate during inflammatory reactions. Endodontic implants are useful for treatment of. C. 84. bacterial products. Pulp polyp 104. Triangular 92. Gram positive organisms 86. Post space preparation The two popular engine-driven instruments are1. 0. Maxillary central incisor The teeth most vulnerable to injury in order of frequency are1. in both straight and curved canals. with the object of increasing the root-to-crown ratio to give the tooth better stability in the arch. or of enamel and dentin. less favorable composition and presence of microorganisms makes saliva a less desirable storage medium for the avulsed tooth. Restorative materials having high thermal conductivity in the absence of proper pulp protection. The hand piece holds a Kfile or a diamond file that produces movements of the shaft of the file when activated. None of the above 100. 102. D. However. 2. Bacterial 77. with interruption of blood flow due to collapse of the pulpal veins which Results in anoxia and localized necrosis. middle 1/3rd premolars 79. Ingress of microbes due to microleakege.12 to 0. Penicillin 103. A. but without pulp involvement. It is not water soluble. At the same appointment 80. Root crown ratio 82. Pulpless teeth with short roots. B. 75. Used to stabilize periodontally weakened teeth with a poor ‘crown:root’ ratio An endodontic implant is a metallic extension of the root. Compaction method 76. Gates Glidden drill: It is used for initial opening of canal orifices and deeper penetration. The same caution holds true for electrosurgical units. D. Culture for 48 – 96 hrs at 37°° C and plating of positive findings 89. Attachments that reduce the amount of surface contact necessary to conduct the electric stimulus are available. Hermann Hermann introduced Ca(OH)2 as a successful pulp capping agent in 1930. Full crown preparations Palpal injuries may be caused by1.Maxillary central incisors. This inability of the pulp to swell creates an abnormally high pressure in an area of Inflammation. ZONE CHARACTERIZED BY Zone of infection PMNs Zone of contamination Round cell infiltration Zone of irritation Macrophages and osteoclasts Zone of stimulation Fibroblasts and osteoblasts 96. C. A. A. This oscillating movement produces the cutting edge of the file. EDTA with urea peroxide RC-Prep is a chelating agent used for removal of smear layer. B. B. B. 5. C. Sodium hypochlorite irrigant solution is delivered alongside the file into the root canal. 4. 87. Transverse root fractures. 78. Storage of avulsed teeth in saliva for 2 to 3 hours causes swelling and membrane damage to periodontal ligament cells owing to saliva’s nonphysiologic osmolality. 3. A. 98.Periodontally involved teeth requiring stabilization. A. 2 hours Avulsed tooth may be stored in saliva for upto 2 hours. However. Cell free zone 10 . Maxillary lateral incisors. 2. H2O2 & sodium perforate bleaching 99. it is preferable to dry storage for short peroids. 2. use of even this small electric stinulus in patients with pacemakers is not recommended. D. 08 to 150 97. A. Its popularity in combination with sodium hypochlorite is enhanced by the interaction of urea peroxide in RC-Prep with sodium hypochlorite. producing a bubbling action thought to loosen and help float out dentinal debris. 81.2008 Modifications of the outline form may be needed to facilitate location of canals and to create a convenience form. which activates a magnetostrictive stack hand piece. Chemical ingredients of restorative materials. D. C. 93. B. any such risk would outweigh the benefit. 3. Notched 85. A. B.38 mm 94. Zone of irritation Fish described the reaction of peri-radicular tissues to noxious products of tissue necrosis. A. A. 88. The nonphysiologic osmolality. Fibrinolysin and polymorphonuclear leukocytes 95. Pacemaker Electric pulp tests are contraindicated in patients who have cardiac pacemakers because they can interfere with the function of the pacemaker. Chemical solutions 83. A.IDEAS WTS MDS ENDODONTICS . Mandibular incisors. A. He demonstrated the formation of secondary dentin over the amputation sites of vital pulps capped with Ca(OH)2. and bridging the tip to a small area of tooth structure with an explorer has been suggested. Piezo reamer: It is most often used in preparing the coronal portion of the root canal for a post and core. B. Root affected by internal resorption. Commonly observed dental trauma is fracture of enamel. Biting on rubber wheel 91. and antigenic agents into 4 well defined zones of reaction. 101. RC prep is composed of EDTA and urea peroxide in a base of carbowax.

Fibroblasts 109. 5 seconds 110.5 and below 116. Streptokinase 124. It is mixed with a sterile liquid such a saline or local anaesthetic solution on a sterile glass slab. 3 mm Indications for apical resection/root end resection/apicoectomy are. Apical third of the root 125. 135. Treatment by apexification should be tried when the pulp has died in a developing tooth with incomplete root formation. Since it will reduce the flora 113. D. It can be best used in canals of size 50 and larger canals and also in those that are relatively straight. Acute exacerbation of a chronic periapical lesion is called a Phoenix abscess. It is the first restorative Material that consistently allows for the overgrowth of cementum. H-files are fragile and fracture easily. B. Two important points to be considered while doing this procedure are1. 120. Periapical abscess Periapical abscess/Dento-alveolar abscess/Alveolar abscess is an acute or chronic suppurative process of the dental periapical region. B. It usually arises as a result of infection following carious involvement of the tooth and pulp. Fibrin and epithelial cells 127. D. Interradicular posts. 114. A. Cemented. They cut in one direction only (retraction). C. A. 2. Bevel greater than100 are undesirable and structurally destructive. 117. C. D. C. Flare the walls of root canals Hedstroem files (H – files) are manufactured from a round stainless steel blank.2008 105. 126. Apical root fracture. The pulp is necrotic Apexification is defined as a method of inducing apical closure by the formation of osteocementum or a similar hard tissue. Persistent symptoms and continued presence of a periradicular lesion. Formerly. Ca(OH)2 paste is used. The purpose of fitting the primary cone short of the canal apex is to avoid inadvertent overfilling of the root canal during condensation.1. All of the above 106. 4. C. At least 5 mm of gutta percha should be retained apically in case of post space preparation. D. 131. 2 -3 mm 136. Removal of broken instruments 130. but it also does occur after traumatic injury to the teeth resulting in necrosis of the pulp and in cases of irritation of the periapical tissues either by mechanical manipulation or by the application of chemicals in endodontic procedures. Penicillin or erythromycin 112. Magnesium carbonate 128. Produce a hermetic seal when set 129. Carbamide peroxide Night Guard/Mouth Guard bleaching technique is widely used as a hone bleaching technique. Lentulo 119. Extent of apical resection-removing 3mm of the root tip. D. Apical third The primary gutta percha should seal the apical canal approximately 1 mm short of the pulpoperiapical juncture.IDEAS WTS MDS ENDODONTICS . 6. where a large cone of gutta percha is placed into the root canal and a special bur –the compactor-is used in a low speed hand piece to both plasticize it and pack it against the root canal walls. it was very popular for filling teeth having resorptive defects. D. Procedural accidents (perforations etc). Its major disadvantage is that it can not be used in narrow and curved canals. B. C. Streptococci and staphylococci 118. Loss of apical seal 122. B. Carbamide peroxide is generally used. Root canal treatment Condition of the pulp Treatment indicated Pulp exposure not over Pulp capping 24 hours Pulp exposure within 72 Pulpotomy/Apexogenesis hours Pulp exposure greater Pulpectomy/ Apexification than 72 hours 111. It is similar to a Reverse Hedstroem file that drives the material back into the canal rather than removes 132. C. and it may facilitate the regeneration of the periodontal ligament. Intracoronal bleaching Sodium perborate Extracoronal bleaching Hydrogen peroxide & Carbamide peroxide 123. None of the above 133. Fine argyrophillic fibers 121. Flutes of a Hedstroem file in reverse Mc Spadden Compactor is a type of thermoplastic gutta percha delivery system. Presence of inflammation in the apical portion of the periodontal ligament 107. C. B. machined to produce spiral flutes resembling cones of a screw. Hyaline bodies 11 . Explanations Exp 11 it. whenever possible. H-files have higher cutting efficiency than K-files. C. A. A. The calcific barrier at the root apex serves as a stop for a gutta percha filling and ensures an adequate seal. B. C. 10 115. Irretrievable root canal filling material. 5. 3. D.Gutta perchan can also be used as a root end filling material. A. Bevelangle-root resection must be done perpendicular to the long axis of the root. 108. B. 2. Mineral Trioxide Aggregate (MTA) MTA is a root end filling material. C. Prevention 134. A. B. The main molecules present in MTA are calcium and phosphorus ions. A. MTA is a new material developed for endodontics that appears to be a significant improvement over other materials for procedures in bone.

Ca(OH)2 paste is best used as an intracanal medicament when one anticipates an Excessive delay between appointments.. The treatment of choice is to observe as long as the tooth remains asymptomatic and no periapical changes are evident. For autoclave sterilization. Submaxillary space 154. Phoenix abscess 12 . All of the above 148. Dentin and Pulp are involved Classification of Ellis and Davey (1960) is as followsClass I Simple fracture of the crown involving little or no dentin Class II Extensive fracture of the crown involving considerable dentin. Black 145. it is strongly recommended that a dentist obtain clearance from the patient's physician prior to treatment.2008 137. 138. Its antimicrobial property The antiseptic action of Ca (OH)2 is probably because of its high pH and its leaching action on necrotic pulp issue. MB 142. The patient will be asymptomatic and the tooth will not respond to pulp vitality testing. however. It is specificically a sharp edged tool for enlarging or tapering holes. A. etc. D. D. B.e.IDEAS WTS MDS ENDODONTICS . Any teeth not contralndlcated are excellent candidates for successful endodontic therapy. but not the pulp Class III Extensive fracture of the crown involving considerable dentin and exposed dental pulp Class IV The traumatized tooth which becomes non-vital with or without loss of crown structure. Reamer – Reamers are instruments that ream. broken instalments. proteolytic activities. C. Porphyromonas and Prevotella These species. Mandibular lateral incisor Class-III restorations are indicated for defects located on the proximal surface of anterior teeth that do not affect the incisal edge. C. burs can be protected by keeping them submerged in a small amount of 2% sodium nitrite solution. 16 mm 156. 2. because it is efficacious as long as it remains within the root canal. 144. Example of a special case: A previously traumatized tooth may show complete obliteration of the pulp chamber and canal. C. B. A. Ca(OH)2 causes a significant increase in pH of circumpulpal dentin when the compound is placed in the root canal. D. The blood stream 139. hemagglutination and hemolysis Fatty acids -* affect chemotaxis and phagocytosis A vital pulp resists bacterial invasion.Barbed broaches are shorthandled instruments used primarily for vital pulp extirpation.) A medical condition such as hemophilia is not a contraindication to conventional endodontic therapy. 151.0% Sodium nitrite Items sensitive to elevated temperatures can not be autoclaved. 6 to 12 months 147. 6. lingual access preparation of the distal surface of the maxillary canine is recommended because the use of amalgam in that location is more likely. Strict anaerobes are found to play a significant role in periapical pathoses. dentinal sclerosis. C. Usually the outline form includes only the proximal surface. H file – H-type files are made by cutting spiraling flutes into the shaft of a piece of a round. D. In contrast. None of the above 150. in the initiation of the lesion. 149. Barbed broach. Class V Loss of tooth Class VI Root fracture with or without loss of crown structure Class VII Displacement of a tooth without fracture of crown or root Class Fracture of crown enmass VIII Class IX Traumatic injuries of deciduous teeth 141. Autoclaving tends to corrode the steel neck and shank portions of some diamond instruments and carbide burs. One probable cause of this phenomenon is increased capillary permeability in the particular area. A. A. B. D. stainless steel wire. Predominant bacterial species isolated from Infected root canals include: Eubacterium species Peptostreptoccus species ■ Fusobacterium species Porphyromonas species Prevotella species Virulence factors which play a role in periradlcular pathosis include: Llpopolysaccharide (LPS) -> found on the surface of gram negative bacteria Enzymes -+ neutralize antibodies and complement components Extracellular vesicles -»involved in bacterial adhesion. They cut in one direction only and are very efficient in cutting. They cut by reaming action. sharp dilacerations. Anachoretic pulpitis Anachoresis refers to the attraction or fixation of blood-borne bacteria in areas of inflammation. the penetration of bacteria may extend no more than 2 mm into the pulp. D. The periodontal ligament may appear normal. Remember Streptococcus spp. C. which were previously classified under bacteroids species merited a separate genus due to their distinct characteristics. B. B. Presence of a fistula 153.63 143. tapered. Enamel. Even if the pulp is exposed to microorganisms for 2 weeks. D. Anachoretic pulpitis probably occurs in a clinically insignificant number of cases of pulpitis compared with the number of cases occurring as a result of dental caries. 146.6% 140. non-vital pulp is a fertile ground for the growth of microorganisms and leads to necrosis. may not be as important in the progress of a carious lesion (leading to pulp exposure) as much as it is. a lingual dovetail may be indicated if one existed previously or if additional retention is needed for a larger restoration. 155. However. 152. All of the above Other contraindications include: A non-strategic tooth -»a tooth not in occlusion A tooth with Explanations Exp 12 massive Internal or external resorption A tooth that has a canal unsuitable for instrumentation or for surgery (i. 873. They are also used to loosen debris in necrotic canals or to remove paper points or cotton pellets. Barbed broach K file – K-file is an ISO Group I instrument traditionally made from a square blank.

Traction method Eg. 1500 This cavosurface design helps seal and protects the margins. Lithium and Aluminium make the glass easier to crush to generate small particles. C.water spray. 173. Air alone as a coolant is not effective because. it is difficult to burnish. Zinc.It needlessly dessicates the dentin. The features are. Apexification with calcium hydroxide 174. B. Damages the odontoblasts. 170. D. B. Dental units should operate at 70kVp or higher. Heat generation. 4) Crack can be visualized by using a dye or transilluminating with fibreoptic light.IDEAS WTS MDS ENDODONTICS . Apical scar 175. Zirconium. D. Use adequate water coolant The use of cutting instruments can harm the pulp by Exposure to mechanical vibration. 6 feet away and in the area that lies between 90° to 135° to x-ray beam). Dessication.5 inches at the patient's skin. Patient should be protected with a lead apron and a thyroid collar for each exposure. Mesiobuccal 165. D. Enamel and dentin are good thermal insulators and the remaining tissue is effective in protecting the pulp in proportion to the square of its thickness. Elicited mainly when pressure is applied Incomplete fractures through the body of the tooth may cause pain of apparently idiopathic origin. D. 179. A. D. Yttrium have been used to produce radiopacity. Atropine The use of drugs to control salivation is rarely indicated in restorative dentistry and is generally limited to the anticholinergic drug-atropine.Wedge method Eg: Elliot separator Wood / plastic wedges . Barium. Stand at least 6 feet away and in the area that lies between 90 to 135 degrees to x-ray beam Notes related to radiation safety: A fast (sensitive) film. 158. In Class-I cavities for direct filling gold or gold inlays. Traction principle There are two principle methods of tooth movement1) Rapid/immediate tooth movement: .e. The most common instrument coolants are1. B. 161. It also recovers more effectively when compared to an older pulp. If there is no barrier for the clinician to stand behind while exposing films.e. B. C. A young pulp is more prone to injury. B. C. B. 167. D. Inorganic filler 183. 176. and also increases its surface free energy. A.. A. the relatively large proportion of low atomic number material in calcium hydroxide causes its radiodensity to be similar to a carious lesion. to identify and differentiate these radiolucent materials from caries by their well-defined and smooth outline reflecting the preparation. Seepage of saliva into the canal 177. Removal of the pulp tissue 171. None of the above 162. Barium and strontium glasses Filler compositions often are modified with other ions to produce desirable changes in properties. 182. Despite the calcium present. Occlusally diverging mesial and distal walls In Class –I cavities for dental amalgam facial & lingual walls are occlusally converging for retention and mesial & distal walls are occlusally diverging.. Labiolingual 168. C. he / she should stand in an area of minimal scatter radiation (i. B. aided by capillary action. irritant 172. Silicate 169. D. When a fluid resin-based material is applied to the irregular etched surface. 164. 3) Diagnostic method is to reproduce the pain by asking the patient to bite on a cotton applicator. Boron. Monomers in the material polymerize. 2) Pain at the initiation of release of biting pressure. the metal is too bulky and when the angle is greater than 400. Air. facial & lingual walls as well as mesial & distal walls are occlusally diverging. Loss of dentinal tubular fluid and/or transection of odontoblastic processes. Co –Cr alloy 160.2008 157. true separator Ferrier double-bow separator 2) Slow/delayed tooth movement Separating wires. Lead or Zinc (added to lend radiopacity) appear radiolucent and may resemble recurrent or residual caries. plastic or silicate restorations also may simulate carious lesions. the lower the patient's skin doses. Low 181.Cracked Tooth Syndrome. Conversely. Non-interfering. restriction of the x-ray beam size so that it does not exceed 2. Both of the above 180. It is often possible however. The higher the kVp.Orthodontic appliances. The formation of resin micro tags within the enamel surface is the fundamental mechanism of adhesion of resin to enamel. B. A. reduces exposure). Much less efficient in absorbing unwanted heat. Oversized temporaries. Carious exposure 159.1) Pain ranges from mild to excruciating pain. the marginal cast metal alloy is too thin and weak. Both a & b 178. A cavosurface enamel angle of more than 1500 is incorrect because it results in a less defined enamel margin and if its angle is less than 300. and the material becomes interlocked with the enamel surface. Steel burs produce more heat than carbide burs. Atropine is contraindicated in Explanations Exp 13 nursing mothers and in patients with glaucoma. C. Collimation (i. Composite. for example E-speed film should be preferred over slower films as faster films require less radiation exposure while providing quality image. Permit chemical bonding between resin and enamel Acid –etching transforms the smooth enamel into a very irregular surface. None of the above 166. the resin penetrates into the surface. Calciumhydroxide cement Older calcium hydroxide liners without Barium. C. 13 . B. Sodium hypochlorite 163. if the enamel margin is 1400 or less. A. Air 2.

184. D. A. 186. C. Acute pulpitis 197.All of the enamel only A bevel is defined as. Radio – opacity 199. Hydrophobic and hydrophilic components The function of the dentin bonding agent is to form and stabilize the hybrid layer. 15 Ibs When a given force is applied. produce resin tags in the unplugged dentinal tubules and effectively seal them to reduce the chances of increased permeability which causes pulpal irritation.any abrupt incline between the two surfaces of prepared tooth or Between the cavity walls and the cavosurface margins in the prepared cavity’. The different types of bevels are1. Hydrophobic. 12 A point angle is the junction of three planal surfaces of different orientation. Disto-facial-occlusal 4. B. C. C.To be able to displace fluids. Hollow bevel It is a concave preparation involving only enamel or enamel and part of dentin 6.IDEAS WTS MDS ENDODONTICS . Disto-lingual-occlusal. Pulpectomy 187. C. 5) As intracanal medicament. Lesser condensation forces are required for spherical amalgam alloys. Barbed braoch 198. or a synthetic resin dissolved in an organic solvent (such as acetone. Mesio. Dentin bonding agents should be both hydrophilic and hydrophobic. One of the advantages of spherical amalgam alloys is that the strength related properties tend to be less sensitive to condensation pressure. Ultra short/ partial Involves part of the enamel bevel 2. the 14 . chloroform and ether). A.C junction 194. thereby wet the surface permitting penetration into porosities within the dentin and react with organic and inorganic components. (Stronger than ZnOEugenol).To allow bonding to composite resin.8N (3 to 4 Ib) are employed for the Condensation of amalgam. In a Permanent mandibular first molar. Long bevel Involves all the enamel wall and upto One half of the dentinal wall 4. Chelation agent 200. 185. C. Ingle’s 191. rosin. the smaller the condenser the greater the pressure exerted on amalgam. 2) As base. C. there are four point angles1.3N-17.facial-occlusal 2. It can induce generation of reparative dentin). Hydrophilic. matrix of which is hydrophobic in nature. Mesio-lingual-occlusal. A. A varnish is not indicated when GIC is used as the coating would eliminate the potential for adhesion. Conventional cavity varnishes should not be employed under composite restorations. Upto D. Incisal occlusal line to apical line 196. 192. 3) As indirect pulp capping agent } Stimulate formation of 4) As direct pulp capping agent. 3.2008 Explanations Exp 14 Dental personnel who may get exposed to occupational xradiation must wear film badges to record exposure and must never exceed the maximum permissible dose (MPD) of 50 mSv per year / whole body. C. Zn phosphate cement The typical cavity varnish is principally a natural gum (such as copal). Dentinal tubule sealing 188. D. Inverted bevel It is an incline in the labial shoulder for metal ceramic crowns. They are basically given to decrease marginal errors. C. 12 The uses of calcium hydroxide are as follows1) As cavity liner. 195. Hollow bevel It includes all the enamel and dentinal wall 5. Instrumentation 193. The pH of calcium hydroxide is basic and varies from 11 to 12. (Calcium hydroxide is suspended in a solvent carrier with a thickening agent. (Due to its antiseptic property). } Reparative dentin. Short bevel Involves the entire enamel wall 3. 189. B. Forces in the range of 13. in Both a & b 190. D. because the solvent in the varnish may soften the resin and the coating prevents proper Wetting of the prepared cavity by the bonding agents. C.